What to ask for now?

[WellyMcLonglegs]

47 yo. Have mirena. I had a blood test to check oestrogen levels. Dr was pretty thorough and made it 5 hours after the application of my oestrogel. Turns out it's being well absorbed, fwiw this was probably around day 15/16 of my cycle (I still get some bleeding most months).

But, I feel meh, I'm exhausted, sleep is disrupted so I go to bed early. I find little to no joy most days. I have absolutely no sex drive at all.

I genuinely do eat well and exercise regularly and try to adopt a good life style to support peri. My Dr started muttering about seeing a lifestyle Dr and I'm not against anything but I'm not sure what they can offer. What do I ask for now?!

Tests for estrogen are quite unreliable.
This website (by drs) explains it very clearly.

https://www.mymenopausecentre.com/gp-resources/oestrogens-and-blood-testing/
If I am using a gel or patch preparation how reliable are blood tests for oestradiol?

When a gel or a patch is applied to the skin the oestradiol in it will move across the skin layers into small capillary blood vessels. There are however many factors that can affect this process including:

• Variations in skin thickness.
• Variations in how closely packed the cells are in your skin.
• Skin temperature. Blood levels of oestradiol seem to be higher in the evenings and lower in the mornings. This is thought to be due to circadian variations in blood flow[1].
• The number of blood vessels present in the area of your skin that your HRT is applied to.
• Surface area of application.
• Pressure applied.
• Skin irritation – you may not be absorbing very well if your skin is irritated by your patches.

Oestradiol levels will also vary considerably from the time of application with any form of oestrogen absorbed through the skin.
Because of these variabilities blood tests can be prone to a lot of error and variation. Even in the same person, results can vary a lot from day to day.

Because of these variabilities blood tests can be prone to a lot of error and variation. Even in the same person, results can vary a lot from day to day.

The usual next step is to increase your gel (up to 4 pumps a day) and / or consider removing the Mirena (which can affect mood a lot) and maybe try another form of progesterone. Have you thought of that?

Thanks for responding.
Tbh no I haven't, I had the mirena put in for unmanageable periods and am worried if it comes out it'll start up again. I've had it a long time (obvs replaced!) with not too much trouble.

There are a few threads going 'live' here at the moment from women wanting their Mirena's removed because of mood issues. It's not uncommon.

But the first step is to increase your estrogen if you've not tried that.